RYAN WHITE HIV/AIDS TREATMENT EXTENSION ACT OF 2009

Background

Part G of the Ryan White HIV/AIDS Treatment Extension Act of 2009 (which amended the Public Health Service Act on October 30, 2009) pertains to the notification of emergency response employees (EREs) who may have been exposed by victims of emergencies to potentially life-threatening infectious diseases. Part G of the Act assigns certain duties to the Secretary of the Department of Health and Human Services (HHS). HHS delegated the Secretary’s duties under Section 2695 (Infectious Diseases and Circumstances Relevant to Notification Requirements) to the Centers for Disease Control and Prevention (CDC), which the National Institute for Occupational Safety and Health (NIOSH), a component of the CDC, recently implemented.

The purpose of Part G is to facilitate informing EREs that they may have been exposed to potentially life-threatening infectious diseases, so they can make better informed decisions about subsequent measures such as diagnosis and, if necessary, prophylaxis or treatment. The medical facility that receives and treats the victim of an emergency or ascertains the cause of death may have or may be able to obtain the victim’s disease status information, which the emergency response service may lack. Part G provides a framework for medical facilities to inform EREs that they may have been exposed to one of the listed diseases.

Pursuant to HHS duties under Section 2695 of Part G, NIOSH has created the following:

• A list of potentially life-threatening infectious diseases. The list is subdivided into those routinely transmitted by: 1) contact or body fluid exposures, 2) aerosolized airborne means, 3) aerosolized droplet means, and 4) agents potentially used for bioterrorism or biological warfare.
• Guidelines describing the circumstances in which employees may be exposed to these diseases.
• Guidelines describing the manner in which medical facilities should make determinations for notification of EREs.

Other Sections of Part G assign roles in the notification of possible exposure to non-federal entities. The following summary of those roles is intended for informational purposes only and should not be construed as a legal interpretation.

Notifications about ERE exposure to one of these listed diseases can arise in either of two ways. First, the ERE may initiate an inquiry based on a potential exposure incident such as a needlestick injury, other contact with body fluids, or suspicion of exposure to an airborne or aerosolized infectious disease. Second, the medical facility provides routine notification if it determines that the victim of an emergency has a listed airborne or aerosolized infectious disease.

To facilitate notification, the Public Health Officer of each state must identify a Designated Officer of each employer of EREs. The Designated Officer is required to respond to requests from an ERE for an assessment of whether the ERE may have been exposed to one of the listed diseases. The Designated Officer will collect and evaluate the facts about the potential exposure incident and make a determination whether an exposure may have occurred. If this is the case, the Designated Officer will submit a request to the medical facility that received the victim.

After receiving a request, the medical facility that provided treatment or ascertained the cause of death will evaluate facts about the exposure incident provided by the Designated Officer and the clinical information known to the medical facility. Based on this information, the medical facility will make a determination if an exposure did or did not occur or if there is inadequate information to make a determination. It provides this information to the Designated Officer, who, in turn, reports to the ERE.

The Designated Officer will also receive routine notifications from medical facilities if they determine that a victim of an emergency transported or cared for by EREs had a listed disease transmitted by airborne or aerosolized means. The Designated Officer, in turn, reports to the ERE.

In reporting exposures to listed infectious diseases to Designated Officers, medical facilities provide the name of the infectious disease and the date when the emergency victim was transported.

Part G requires medical facilities to respond to requests from Designated Officers as soon as is practicable, but no later than 48 hours after receiving the request.

Part G also requires notification as soon as is practicable, but not later than 48 hours, from medical facilities to Designated Officers after determining that a transported victim has a listed airborne or aerosolized infectious disease.

Flow Charts

Procedures for notification of possible exposure to infectious diseases under the Ryan White HIV/AIDS Treatment Extension Act of 2009. These flow charts are provided for informational purposes only. They are not official guidance. If discrepancies are noted, statutory language found in 42 U.S.C. 300ff-131 to 300ff-140 should always take precedence over these figures.

• Figure 1. Medical facility initiates the routine notification of listed airborne or aerosolized infectious disease [PDF – 18 KB]
• Figure 2. Emergency response employee requests information about possible exposure to listed disease [PDF – 24 KB]
• Figure 3. Designated Officer requests the assistance of Public Health Officer when medical facility finds that facts about exposure are insufficient[PDF – 23 KB]

Resources

The Ryan White HIV/AIDS Treatment Extension Act of 2009 [PDF – 195 KB]
Part G begins on page 13 of the pdf.

Department of Health and Human Services/Centers for Disease Control and Prevention: Federal Register Notice (November 2, 2011) implementing provisions of the Ryan White Act of 2009 [PDF – 179 KB]

Occupational safety and health contacts at State and Territorial Health Departments.

Emergency Responder Health Monitoring and Surveillance Document